摘要
目的 探讨恶性血液病患者行挽救性二次造血干细胞移植后巨细胞病毒（CMV）及EB病毒（EBV）感染的状况.方法 选择2009年9月至2016年10月行二次造血干细胞移植的25例患者为研究对象,用实时定量PCR方法定期检测移植后外周血CMV及EBV DNA,分析二次造血干细胞移植后病毒感染的情况及影响因素.结果 二次造血干细胞移植后CMV总的感染率为52.0％（13/25）,其中干细胞来源于骨髓组CMV感染的发生率为100％ （2/2）,外周血干细胞组为33.3％（5/15）,混合组（骨髓＋外周血干细胞）为75％ （6/8）,三组比较差异有统计学意义（P=0.038）,各组两两相互比较差异无统计学意义（P＞0.05）.分析不同移植方式各组CMV感染的发生率,差异无统计学意义（P＞0.05）.对采用清髓/非清髓预处理方案组、不同GVHD预防方案组、不同急性GVHD严重程度组,各自比较移植后CMV感染的发生率,差异无统计学意义（P＞0.05）.二次造血干细胞移植后EBV总的感染率为24.0％（6/25）,其中干细胞来源于骨髓组EBV感染的发生率为100％ （2/2）,外周血干细胞组为6.7％（1/15）,骨髓＋外周血干细胞组为37.5％（3/8）,三组比较,差异有统计学意义（P=0.008）,骨髓组EBV感染率高于外周血干细胞组（P=0.022）,骨髓组与混合组比较,差异无统计学意义（P＞0.05）,外周血干细胞组与混合组比较,差异无统计学意义（P＞0.05）.分析不同移植方式各组EBV感染的发生率,差异有统计学意义（P=0.007）.单倍体组EBV感染率为71.4％,高于同胞全相合组（0％）和自体组（0％）,差异有统计学意义（P=0.021和P=0.028）,余下各组两两相互比较,差异无统计学意义（P＞0.05）.对采用清髓/非清髓预处理方案组、不同GVHD预防方案组、不同急性GVHD严重程度组,各自比较移植后EBV感染的发生率,差异无统计学意义（P＞0.05）.结论 二次造血干细胞移植后CMV及EB病毒感染发生率较高,移植方式及干细胞的来源与二次造血干细胞移植后CMV及EBV感染相关.
Objective To explore the clinical features of cytomegalovirus （CMV） and EpsteinBarr virus （EBV） infection after second hematopoietic stem cell transplantation （HSCT）.Methods Twenty-five patients after second HSCT from Sep.2009 to Oct.2016 were collected,and CMV and EBV DNA in peripheral blood was detected regularly by polymerase chain reaction （PCR）.Factors associated were compared by univariate analysis.Results The total incidence of CMV infection was 52.0% （13/25） after second HSCT.The incidence of CMV infection was 100% （2/2）,33.3% （5/15） and 75% （6/8） in bone marrow group,peripheral blood stem cell group,and mixed group,respectively.Stem cell sources were significantly correlated with CMV infection （P =0.038）,however,there was no significant difference in CMV infection rate among three groups （P〉0.05）.None of preconditioning regimen,GVHD prophylaxis programs or severity of aGVHD were correlated with CMV infection after second HSCT （P〉0.05）.The total incidence of EBV infection was 24.0% （6/25） after second HSCT.The incidence of EBV infection was 100% （2/2）,6.7% （1/15） and 37.5% （3/8） in bone marrow group,peripheral blood stem cell group,and mixed group,respectively.Stem cell sources were significantly correlated with EBV infection （P =0.008）.The EBV infection rate in bone marrow group was significantly higher than that in peripheral blood group （P =0.022）,however,no significant differences were found between bone marrow group and mixed group,as well as between peripheral blood group and mixed group （P〉0.05）.Transplant methods were significantly correlated with EBV infection （P =0.007）.The EBV infection rate in haploidentical HSCT group （71.4%） was significantly higher than that in HLA-matched sibling HSCT group （0%） and autologous HSCT group （0%） （P =0.021 and 0.028）,however,no significant differences were found between any other two groups （P〉0.05）.None of preconditioning regimen,GVHD prophylaxis programs or severity of aGVHD were correlated with EBV infection after second HSCT （P〉0.05）.Conclusion The incidence of CMV and EBV infection in patients undergoing second HSCT is high.Stem cell sources and transplant methods are associated with CMV and EBV infection after second HSCT.
作者
姚遥
李晓莉
杨冰玉
刘立民
韩悦
唐晓文
傅铮铮
吴小津
吴德沛
Yao Yao, Li Xiaoli, Yang Bingyu, Liu Limin, Han Yue, Tang Xiaowen , Fu Zhengzheng , Wu Xiaojin , Wu Depei.(Department of Hematology, First Affiliated Hospital of Soochow University, Suzhou 215006, Chin)
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2018年第4期227-231,共5页
Chinese Journal of Organ Transplantation
基金
江苏省自然科学基金（BK20141202）
国家重点研发计划（2016YFC0902800,2017YFA0104502,2017ZX09304021）
关键词
造血干细胞移植
巨细胞病毒
EB病毒
Hematopoietic stem cell transplantation
Cytomegalovirus
Epstein-Parr virus
